<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html><head>
          <?php $this->load->view('panggil_css'); ?>
          <?php $this->load->view('panggil_js'); ?>
          <title>registrasi</title>
          <?php $this->load->view('header') ?>
     </head>
     <body>
          <div class="container-fluid">
               <div class="row-fluid">
                    <div class="span3">
                         <!--Sidebar content-->
                    </div>
                    <div class="well span8">
                         <div class="alert alert-info"><h3><b>Registrasi Pasien Baru</b></h3></div>
                         <div class="form-actions">

                              <div class="span6">
                                   <?php $span = "span12"; ?>
                                   <?php echo form_open('registrasi/submit_sign_up'); ?>
                                        <?php echo form_error('nama_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_input($nama_user) ?>
                                        <?php echo form_error('username_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_input($username_user) ?>
                                        <?php echo form_error('password_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_password($password_user) ?>
                                        <?php echo form_error('re_password_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_password($re_password_user) ?>
                                        <?php echo form_error('tempat_lahir_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_input($tempat_lahir_user) ?>
                                        <?php echo form_error('tanggal_lahir_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_input($tanggal_lahir_user) ?>
                                        <?php echo form_error('alamat_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_textarea($alamat_user) ?>
                                        <?php echo form_error('no_ktp_user', '<br /><div class='.$span.'><div class="alert alert-error"> <button class="close" data-dismiss="alert">&times;</button>', '</div></div>'); ?>
                                        <?php echo form_input($no_ktp_user) ?>

                                        <div class="form-actions">
                                             <?php echo form_submit('submit', 'Submit', 'class="btn btn-large btn-primary"'); ?>
                                             <?php echo form_close(); ?>
                                        </div>
                              </div>
                              <div class="span6">
                                   <!--kanan-->
                                   <ul class="thumbnails">
                                        <li class="span12">
                                             <br><br><br><br>
                                             <div class="thumbnail">
                                                  <img src="<?php echo base_url().'bootstrap/img/360x268.gif' ?>" alt="">
                                                  <h5><strong>FORUM SEHAT</strong></h5>
                                                  <p>Temukan solusi permasalahan kesehatan anak anda di forum ini secara otomatis dengan nara sumber dokter anak.</p>
                                                  
                                             </div>
                                        </li>
                                   </ul>
                              </div>
                         </div>
                    </div>
               </div>
          </div>

     </body>
</html>


